Chances are you’ve heard about Seasonal Affective Disorder (or SAD) – the period of depression that some people tend to experience just after Christmas and that seems to linger until spring. Maybe you’ve even diagnosed yourself with it or attributed someone’s bad mood to it! But what is it exactly? And have we been using the diagnosis appropriately or as a blanket statement to describe the winter blues?
What is SAD?
The DSM-V (Diagnostic and Statistical Manual of Mental Disorders) is a manual that clinicians use to diagnose various mental health conditions. While Seasonal Affective Disorder does not have its own diagnosis in the DSM-V, the manual recognizes that major depressive episodes can have a seasonal pattern. As the National Institute of Mental Health (NIMH) puts it, SAD is not considered a disorder separate from depression, but it’s a type of depression that recurs in a seasonal pattern. In order to be diagnosed with SAD, you must meet the full criteria for major depression coinciding with specific seasons (appearing in the winter or summer months) for at least two years, and these seasonal depressions must be more frequent than any non-seasonal depressions. Seasonal depression during the fall and winter months is most common, although seasonal depression can occur during the spring and summer as well.
What makes it different?
How does it differ from Major Depression or Persistent Depressive Disorder (also known as Dysthymia), which are diagnoses in the DSM-V? Major Depressive Disorder and Persistent Depressive Disorder do not necessarily follow a seasonal pattern. An essential feature of SAD is the onset and remission of major depressive episodes at characteristic times of the year. While depressive episodes may be sporadic in other depressive disorders, depressive episodes in SAD follow a seasonal pattern. So, you may have SAD if you’ve experienced at least two major depressive episodes at the same time of the year for two years in a row, with no major depressive episodes during the other seasons of the year. Also, your depressive episodes cannot be attributed to another reason, such as stress at work, overwhelmed with family activities, etc.
What exactly do we mean by “major depressive episode”? According to the Mayo Clinic, symptoms of a depressive episode may include: feeling depressed most of the day, nearly every day; loss of interest in activities you normally enjoy; low energy; difficulty sleeping; changes in appetite and/or weight; feeling sluggish or agitated; feelings of hopelessness; thoughts of death or suicide. Common symptoms of a major depressive episode in the fall and winter include: oversleeping, appetite changes, weight gain, tiredness or low energy. Common symptoms of a major depressive episode in the spring and summer include trouble sleeping, poor appetite, weight loss, agitation, and anxiety. The DSM-V even lists “a craving for carbohydrates” as one of the symptoms of a seasonal depressive episode!
Causes
So, why do some people experience seasonal patterns of depression? The Mayo Clinic says that while there is no specific cause, there are influencing factors. For example, decreased sunlight can disrupt our internal clock and circadian rhythms, which can lead to feelings of depression. Some studies have shown a connection between low amounts of vitamin D (which we get from the sunlight) and depression, which may explain why SAD is most common in the fall and winter months, when there is less sunlight. According to NIMH, vitamin D is believed to play a role in serotonin activity, the neurotransmitter that contributes to feelings of happiness. An insufficiency in vitamin D and/or an insufficient or unbalanced amount of serotonin, then, may be associated with clinically significant depression symptoms.
Our body’s melatonin levels also play a part. Changes in season can disrupt our levels of melatonin, which plays a role in our sleep patterns and overall mood, according to the Mayo Clinic. As the NIMH puts it: “Darkness increases production of melatonin, which regulates sleep. As winter days become shorter, melatonin production increases, leaving people with SAD to feel sleepier and more lethargic, often with delayed circadian rhythms.” According to the DSM-V, the occurrence of fall/winter seasonal depression seems to vary according to latitude, age, and sex. The prevalence of SAD increases with higher latitudes, and younger people are also at higher risk for winter depressive episodes.
Treatment
How do you treat SAD? For some, taking a vitamin D supplement can help, especially if they have low levels of vitamin D in their blood. However, the NIMH warns against treating SAD only with a supplement due to the fact that low levels of vitamin D are usually due to “insufficient dietary intake or insufficient exposure to sunshine.” In other words, you may be able to increase your vitamin D intake by incorporating more into your diet and by spending more time outdoors. The evidence for the effectiveness of vitamin D supplements have been mixed—some studies show that it has been largely effective, while others found it has no effect.
Another treatment option is light therapy, or phototherapy. The idea is to replace the decreased amount of sunshine of the fall and winter months with daily exposure to bright, artificial light. Folks may experience relief from their symptoms by sitting in front of a light box that contains 10,000 lux of cool-white fluorescent light and that filters out ultraviolet rays for 20-60 minutes daily. This special light is about 20 times greater than ordinary indoor lighting.
Like other depressive disorders, psychotherapy and medication can be helpful in treating SAD. Selective Serotonin Reuptake Inhibitors (SSRIs) and Bupropion (another type of antidepressant) have been found to be effective in treating SAD. Cognitive Behavior Therapy (CBT) and Acceptance and Commitment Therapy (you can read more about ACT here) can be adapted for SAD, by identifying negative thoughts and replacing them with more positive thoughts. Behavioral activation is another CBT technique that helps the person identify activities that are engaging and pleasurable, whether indoors or outdoors, to improve coping with winter.
If you think you might meet criteria for SAD, I encourage you to make an appointment with your doctor, a psychiatrist, and/or therapist to discuss your concerns and possible treatment options. Not sure you meet the qualifications for SAD, but still feeling yourself fighting winter blues? Here are some tips:
- Bundle up and get outside when you can! Even if it’s cloudy, you can still reap benefit from the sun by getting outside for a few minutes. Take a short, brisk walk on your lunch break. That will also boost endorphins, which helps fight the blues!
- Practice gratitude. While practicing gratitude may not alleviate your negative feelings, it has been shown to help boost positive feelings, even in the midst of difficulty. Making a list of the things you’re thankful for can be helpful. If you’re struggling to come up with things to put on your list, pay attention to your five senses and what they’re noticing, and give thanks for those sensations – it can be amazing to realize what all our bodies can do, sense, and feel!
- Connect. Whether it’s over coffee with a friend, at the water cooler with a co-worker, or even with a therapist, connection helps us to feel less isolated and alone, and reminds us that we all struggle at various points in our lives.
So, there you have it! I hope this blog post has demystified SAD for you! The great news about this disorder—like most other disorders—is that it’s completely treatable! If you have questions about I treat SAD, please contact me at (314) 392-2895 today!
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Seasonal affective disorder (SAD). (n.d.). Retrieved January 16, 2019, from https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651
Seasonal affective disorder. (2016). Retrieved January 16, 2019 from https://www.nimh.nih.gov/health/topics/seasonal-affective-disorder/index.shtml
